"Total Sanitation" in Bangladesh

Thanks to an innovative community-based approach, a new campaign for improved access to sanitation that was launched in Bangladesh at the end of the 1990s is having a sustainable impact, where other previous projects had failed.

The “total sanitation” campaign in Bangladesh (or to give it the full title used by the promoter, community-led total sanitation or CLTS) is an example of a bottom-up initiative, founded by a local NGO, and that has progressively been taken up by local government authorities and the international institutions and extended to other countries.

This approach was developed by Kamal Kar, a consultant based in Kolkata (Calcutta), who began to implement it in 1999 with the support of WaterAid, the international NGO, and a Bangladeshi organisation called VERC (Village Education Resources Centre). The approach was a response to a failure: 30 years of international aid and presence of NGOs in rural areas had not had conclusive results in terms of extending the sanitation systems to the rural areas of Bangladesh. Even if the there was an apparent increase in the areas covered, the practice of defecating in the open was not decreasing, and continued to lead to disease and even in some cases to death. The idea of total sanitation emphasizes community participation, in the real sense of the term. It involves helping village inhabitants to identify the fact that defecating in the open is a problem and constitutes dangerous behaviour, thereby creating the “demand” for suitably adapted sanitation equipment.

The basis of the approach: education and participation

The starting point for the approach that Kamal Kar promoted was to impact the cultural representations and the accepted behaviour, by becoming involved with the communities to help them to understand the problems connected with defecating in the open. The approach involved getting village inhabitants to add up the quantity of excrement of a village; there were visits to the dirtiest areas; a map of the village was drawn, that showed the route taken by the inhabitants to were they defecated; the way that disease was spread from the excrement to the food eaten by the inhabitants was also tracked. This led to communities opening their eyes to their practice, and becoming aware of the consequences of their sanitary habits. This had the effect of mobilising some of the residents, who organised themselves into “sanitary action groups” to raise awareness of their neighbours, and build their own equipment, with external support. It was a clear case of encouraging a form of “social pressure” on anyone who was recalcitrant, and leading to progressive change in habits and mentalities.

This process created a social demand that had hitherto not existed. The approach of total sanitation, as initially conceived, did not involve any particular technical solution, or even a range of solutions. It was simply a matter of encouraging families to develop the most suitable solution according to their means, as well as identifying and encouraging the most inventive inhabitants to offer their services to their neighbours. Exchanging experiences have also been organised at national or regional level. Experience proves that village inhabitants are able to develop very low cost solutions, using local materials.

Generalisation

The approach to total sanitation has now been rolled out by many big local and Western NGOs working in Bangladesh. This generalisation is accompanied by changes in practice and methods that sometimes appear to be against the original spirit of the approach, but that have no doubt made it more viable on a large scale. This has encouraged the development of the sector of small companies dedicated to the design and building of low cost latrines. These small local companies have taken advantage of the demand that has sprung up everywhere; there are now thousands of them. The result is that the latrines are increasingly cheap. Specific micro-credit structures have also been created to help households become equipped.

The government of Bangladesh has also contributed, as it has launched an ambitious programme aimed at total sanitation coverage of the country by 2010. This programme is based on the principles of total sanitation, that is to say that they prioritise the creation of demand through awareness-raising and have introduced a series of supporting measures, including training and facilitating of partnerships between communities and small local companies. 600 NGOs, UNICEF, and local authorities all proclaim the virtues of sanitation in the villages of Bangladesh.

The effort that has been made by the authorities has had concrete results, because Bangladesh has now overtaken their Indian neighbours in terms of access to sanitation, although the two countries were at an identical level ten years ago, and India has had much stronger economic growth. Nevertheless certain difficulties remain. Although there has been real progress in rural areas, the same cannot be said of slums. Even in rural areas, the Bangladesh authorities are worried about the fact that poor households do not have the means to finance even low cost latrines, and have set up a programme to subsidise their requests.

This approach has now become recognised as being particularly efficient, and total community sanitation has been taken up by many local and international NGOs as well as even governments in other countries, mainly in Asia and Africa.